1. Pulmonary-Systemic Pressure Ratio Correlates with Morbidity in Cardiac Valve Surgery.
- Author
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Schubert SA, Mehaffey JH, Booth A, Yarboro LT, Kern JA, Kennedy JLW, Ailawadi G, and Mazimba S
- Subjects
- Aged, Cardiac Catheterization mortality, Cardiac Catheterization trends, Cardiac Surgical Procedures trends, Cohort Studies, Female, Heart Valve Prosthesis Implantation trends, Humans, Hypertension, Pulmonary physiopathology, Hypertension, Pulmonary surgery, Male, Middle Aged, Morbidity trends, Postoperative Complications diagnosis, Postoperative Complications physiopathology, Preoperative Care trends, Retrospective Studies, Arterial Pressure physiology, Cardiac Surgical Procedures mortality, Heart Valve Prosthesis Implantation mortality, Hypertension, Pulmonary mortality, Postoperative Complications mortality, Preoperative Care mortality
- Abstract
Objectives: Pulmonary hypertension portends worse outcomes in cardiac valve surgery; however, isolated pulmonary artery pressures may not reflect patients' global cardiac function accurately. To better account for the interventricular relationship, the authors hypothesized that patients with greater pulmonary-systemic ratios (mean pulmonary arterial pressure)/(mean systemic arterial pressure) would correlate with worse outcomes after valve surgery., Design: Retrospective cohort study., Setting: Single academic hospital., Participants: The study comprised 314 patients undergoing valve surgery with or without coronary artery bypass grafting (2004-2016) with Society of Thoracic Surgeons predicted risk scores and preoperative right heart catheterization., Interventions: None., Measurements and Main Results: The pulmonary-systemic ratio was calculated as follows: mean pulmonary arterial pressure/mean systemic arterial pressure. Patients were stratified by pulmonary-systemic ratio quartile. Logistic regression was used to assess the risk-adjusted association between pulmonary-systemic ratio or mean pulmonary arterial pressure. Median pulmonary-systemic ratio was 0.33 (Q1-Q3: 0.23-0.65); median pulmonary arterial pressure was 29 (21-30) mmHg. Patients with the highest pulmonary-systemic ratio had the highest rates of morbidity and mortality (p < 0.0001). A high pulmonary-systemic ratio was associated with longer duration in the intensive care unit (p < 0.0001) and hospital (p < 0.0001). After risk-adjustment, pulmonary-systemic ratio and pulmonary arterial pressure were independently associated with morbidity and mortality, but the pulmonary-systemic ratio (odds ratio 23.88, p = 0.008, Wald 7.1) was more strongly associated than the pulmonary arterial pressure (odds ratio 1.035, p = 0.011, Wald 6.5)., Conclusions: The pulmonary-systemic ratio is more strongly associated with risk-adjusted morbidity and mortality in valve surgery than pulmonary arterial pressure. By integrating ventricular interactions, this metric may better characterize the risk of valve surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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